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News & Updates

6/25/14 -51 Modifier Update

We recently alerted you that Optum will soon cease requiring the -51 modifier be appended to the 98943 code, which led to a reduced reimbursement.   Since that announcement we have heard from many of our members that United Health Care has been denying 98943 claims that include the -51 modifier, prior to this scheduled policy change.  Further, several of our members informed us that representatives of UHC had advised that the -59 modifier was now required on the 98943 code. 

I have spoken with management at Optum who investigated these issues within their own ranks as well as United, which is their parent company.  The explanation received is that these denials had taken place due to testing of the policy change regarding the -51 modifier within the IT system. 

I have been told that the implementation date for the new policy of NOT requiring the -51 modifier on 98943 has been moved up to July 16th, rather than July 31st as we originally reported.  I have also been advised that until this date, the 98943 codes billed to United or their affiliates, Optum and Oxford, do still require the -51 modifier. 

If you have received denials for having the -51 modifier on 98943 claims to United or its affiliates and you are going to resubmit them BEFORE July 16th, you should include the -51 modifier.  I know this is confusing since the claims were originally denied for having that modifier, but this is what I have been advised by Optum management. 

As of July 16th 2014, the -51 modifier will NOT be required on 98943 claims by United or its affiliates.

Important Notes:

  1. The modifier will no longer be required as of the PROCESSING date of 7/16/14.  So you should not append the -51 modifier to a 98943 code being billed to United, Optum, Oxford, etc. if the claim will be processed on or after 7/16/14, regardless of the date of service. 
  2. Any claims to these carriers that are processed on or after 7/16/14 that include the -51 modifier on 98943 will be denied for having an inappropriate modifier.  So please be sure to update your billing to remove this modifier after that date of policy change!

    I have inquired several times with Optum/UHC and have confirmed there is no requirement nor any plan to implement a requirement of the -59 modifier being appended to the 98943 code. 

    For additional carrier assistance providers can contact Optum at (800) 344-4584.

    If you have any questions about this message or if you receive denials or other claim responses that do not match up with the policies described here please email me at  Thank you.

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